Spending on prescription drugs continues to be one of the fastest-growing healthcare costs facing customers. Factors that have driven the increases in prescription drug spending include increased use of disease-preventative and quality-of-life enhancing drugs by patients, direct marketing to patients by pharmaceutical companies, usage changes to newer, higher-cost drugs, and price increases by manufacturers and the lack of prescriber and customer information and participation in pharmacoeconomic discussions and choice. A particular problem with prescription drug costs is that many patients who lack prescription drug coverage often pay more for prescriptions than those who do have coverage. This is usually due to “cost shifting” by pharmacies, who attempt to collect larger profit margins from patients with limited buying power and information to compensate for the reduced profits available from insured patients having prescription plans with pre-negotiated price schedules. The result is that uninsured patients, who have little or no market leverage as individuals, pay higher prices for prescriptions than other payers in the marketplace, such as third party payers, insurance companies, the government and the like.
In order to assist those individuals who lack prescription drug coverage, discount drug card programs have been offered by organizations wherein subscribers to the programs receive monetary discounts from participating pharmacies. However, since the discount drug card programs require that the patient pay 100% of the price of the prescription at the time they receive the medication, and since the pharmacist may not be required to adjudicate benefits or discounts through a third party, there is no assurance that the patient will receive the correct discounted price and the patient advocacy that the participating pharmacy had originally contracted to provide under the terms of the discount drug card program.
Third party payment programs, on the other hand, have used many tools to control drug costs; they decreased treatment options, cut pharmacy services, received perverse incentives from pharmaceutical manufacturers, increased co-pays to decrease costs and/or access to some drug therapies, and limited access to providers.
Many patients are unable to purchase needed medication because it is either too expensive or limited by their health insurance plan. Such patients are considered to be “undertreated.” Undertreated patients are prone to treatment failures, often must be hospitalized at a greater expense to the healthcare system, and frequently suffer increased morbidity and mortality.
The current system is replete with perverse methods to shift the cost of drug therapy to the customer by means of various incentives for the prescribers, dispensers, consultants, PBM's, HMO's, insurance companies, and others. These perverse incentives act to increase patients' cost of drug therapy or prevent patients from receiving desired products and/or pharmacy services, satisfying profitability motives of the above-listed parties at the expense of the customer. There is a need for tools that allow customers to obtain prescription drugs and services and to consistently provide drug price discounts to customers and increases the availability of desired pharmacy services while holding down the total cost of health care.